| NPI | 1154534790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 7102) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OH 7102) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 7102) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: OH 7102) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 7102) | |
| 103TF0000X Psychologist, Family (Licence: OH 7102) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OH 7102) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 7102) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2014-01-28 |